Laura J. Esserman, MD, MBA

Statins and Breast Cancer: Dr. Esserman and team have recently completed a clinical trial evaluating the effects of statins on breast cancer and have a manuscript prepared and ready for submission for publication. Following on the heels of this trial, they have designed an adjuvant DCIS trial with a nested correlative science window trial to study the effects of statins in DCIS. In addition, they are continuing studies on the mechanism(s) of statins' anticancer effects and are developing a gene expression signature profile for statin responsiveness.

Macrophages and Breast Cancer: Tumor-associated macrophages (TAMs) exist in the microenvironment of many tumors, and can affect different aspects of the cancer's growth. As such, TAMs represent a potential target for anti-cancer therapy. The researchers are currently testing macrophage targeting agents in a laboratory model of breast cancer. They have recently demonstrated the presence of different subsets of macrophages in breast cancer tissues from patients at UCSF and are expanding these studies to include women from West Africa. Finally, viruses may be a mechanism by which macrophages are activated in certain breast cancers, contributing to a worse outcome. If this is the case, it would lead us to a remarkable prevention strategy, that of a vaccine. Dr. Esserman isa working with Dr. Joe Derisi, a renowned virus expert who has developed the "Virochip" technology, to search for a breast cancer related virus.

The I SPY TRIAL is a national trial of molecular markers and imaging to characterize women with locally advanced breast cancer and their response to standard chemotherapy. The original trial was stopped after 237 patients were enrolled. Dr. Esserman's team has presented over 20 abstracts and is in the process of writing 3 manuscripts summarizing results. They have learned that most of the cancers that present are not screen detected and are learning about the specific response to chemotherapy by molecular and protein signatures. The trial was amended to include MR spectroscopy, an imaging biomarker (measuring choline peaks in tumor tissue), to determine if early changes predict overall response to a specific chemotherapy regimen. Pat Bolen, PhD, worked with all of the sites to standardize imaging techniques and spectroscopy data acquisition. The trial is currently open and enrolling at all sites.

Mid-Year Progress Report:
Statins and Breast Cancer: Dr. Esserman's team has recently completed a clinical trial evaluating the effects of statins on breast cancer. Following on the heels of this trial, they have designed an adjuvant DCIS trial with a nested correlative science window trial to study the effects of statins in DCIS. The protocol for this trial was approved by the CALGB executive committee and was submitted to the Division of Cancer Prevention and the Clinical Trials Evaluation Branch for approval. They have recommended that the UCSF researchers conduct the study as a shorter, more focused biomarker study, and they are in the process of revising the protocol. In addition, they are continuing their studies on the mechanism(s) of statins' anti-cancer effects, including developing a gene expression signature profile for statin responsiveness and testing the effects of statins in combination with standard chemotherapy to prevent or reverse drug resistance.

Macrophages and Breast Cancer: Tumor-associated macrophages (TAMs) exist in the microenvironment of many tumors, and can affect different aspects of the cancer's growth. As such, TAMs represent a potential target for anti-cancer therapy. Dr. Esserman and colleagues are currently testing macrophage targeting agents in a laboratory model of breast cancer. They have recently demonstrated the presence of different subsets of macrophages in breast cancer tissues from patients at UCSF and have expanded these studies to include women from underserved communities as well as women from West Africa.

Bio:
Laura Esserman is Professor of Surgery and Radiology at the University of California, San Francisco (UCSF) and the Director of the UCSF/Mt. Zion Carol Franc Buck Breast Care Center. Dr. Esserman received her undergraduate degree from Harvard and her MD from Stanford University, where she completed her surgical residency and an oncology fellowship. After completing her medical training, she was awarded a Hartford Fellowship to enable her to pursue her MBA at the Stanford University School of Business. Dr. Esserman has a joint appointment in the Departments of Surgery and Radiology and is affiliate faculty for the Institute for Health Policy Studies and Medical Informatics Program. She is also the Co-leader of the Breast Oncology Program of the UCSF Cancer Center.

Dr. Esserman's practice is devoted to diseases of the breast, particularly breast cancer. At the Breast Cancer Center, patients are looked at as a whole person, and are not identified by their disease. This philosophy is behind Dr. Esserman's interest in helping women become more involved in their own decision making process. The Center is designed to advance the state of the art of delivering breast healthcare through better tools for risk assessment, better prediction of benefit from intervention, knowledge integration across the many disciplines and providers involved in care delivery, and integration of clinical research into the patient care process. The Center was created as part of a multi-million dollar grant, one of three awarded nationally, from the Department of Defense. Novel approaches include the introduction of a collaborative care decision focused model, where patients and physicians make decisions together, and the introduction and testing of tools to use risk assessment and new biological markers explicitly in therapeutic decision making.

Dr. Esserman is also involved in research and furthering the knowledge of providers as well as patients. Current projects include: the development of a vaccine for treatment of ductal carcinoma in situ; clinical trials designed around biomarkers; and developing MRI imaging as a surrogate marker of disease and response in order to improve cancer staging and enable the introduction of novel therapeutics. She also speaks extensively at many public and private forums and has published numerous articles covering a broad range of topics, from immunology to health policy and health care delivery. The philosophy underlying Dr. Esserman's research and practice is to ensure that a patient's sense of comfort, knowledge, and participation are central in delivering the best care possible.